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My hospital is floating nurses to units they arenít trained to work on. How can these nurses protect the patients and their licensure?

Saturday February 6, 2010
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Dear Nancy,
My hospital recently blended units (PCU with MICU, SICU with heart-lung transplant). Since non-ICU/MICU trained nurses (med/surg, oncology, medical, ortho) floated to the PCU and HTLU units before the merge, management now expects these same nurses to float to the blended units. The new expectations are causing great concern because nurses are unfamiliar with the specialty drugs, equipment, central lines (Swan's, etc.), and the general critical condition of the patients. No preparatory education has been offered or required. What recourse do the nurses have to protect the patients and their professional licensure?


Nancy Brent replies:

Dear Doug,
Your concern about the situation you described is certainly well founded and understandable. It is unusual that the hospital is not concerned about this situation as well. It appears they are relying on the non-ICU/MICU nursesí prior orientation (Iím assuming there was such an orientation) and floating experience. From your perspective, this prior orientation and experience is not adequate. Remember, you and your fellow nurse colleagues in the unit are the "experts" in the specialty care you provide. This does not mean others cannot learn the skills and other requirements needed to care for the patients in the unit. However, the non-ICU/MICU nurses may not meet the expectations needed to provide safe, non-negligent care to the patients without additional orientation.

You may want to raise those concerns with your CNO and with the hospital's risk management department. The CNO can hopefully intervene and require additional orientation to the new unit. Likewise, because risk management's role, among others, is to decrease the risk, financially and legally, to the institution, he or she can also help make a change in the current situation.

The facility could face liability for any patient injury legally connected to the use of incompetent nurses under the Corporate or Institutional Theory of Liability. This theory requires a healthcare facility to use competent nursing (and other staff) to provide treatment to patients. Likewise, if the CNO knows, or should know, that there is an unreasonable and foreseeable risk of harm to a patient (e.g., not using competent nursing staff), his or her duty to protect the patient also is breached because of the failure to uphold the duty of a CNO in this circumstance.

Raising your concerns meets your ethical and legal responsibilities to the patients in the situation described. Doing so as soon as possible will help administration understand what your issues are and everyone can work toward providing safe and competent care to the patients in the new unit.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.